Large health system optimizes financial performance by reviewing managed care contracts

Client background   

An established health system located in southern New Jersey, offering acute care services and representing a large sample of childbirths in the region.  

The business challenge   

The health system wanted to ensure their managed care agreements were competitive across the southern New Jersey marketplace.  

Baker Tilly’s solution-driven approach   

To help the health system evaluate the competitiveness of their managed care contracts, Baker Tilly took both a quantitative approach to assess their market position, including a comparative market analysis and benchmarking their commercial claims. 

Comparative market analysis 

Baker Tilly conducted a comparative market analysis of clients’ contracted rates based on administrative claims data provided by the client, as well as leveraging data from our internal repositories. 

Benchmark against commercial claims 

Baker Tilly also benchmarked the administrative claims against other competitors in the region by analyzing the client’s reimbursement rates, as well as proprietary marketplace intelligence for government and commercial service lines.  

The accomplished results    

With the help of Baker Tilly, the health system successfully identified areas where they could enhance their managed care rates to match market competitiveness against their peers. Baker Tilly identified upwards of $90 million dollars of potential opportunity to be negotiated with health plans based on outcomes of the quantitative review.